Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017

Abstract

Background Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland. Methods The data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups. Results The proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p. Conclusions The achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.

Association of personalised care plans with monitoring and control of clinical outcomes, prescription of medication and utilisation of primary care services in patients with type 2 diabetes: an observational real-world study

“…More care plan entries reflected longer follow-up periods and thus, longer diabetes durations, which worsened diabetic control [ 20 ]. Another study from Finland showed that the HbA1c levels fluctuated from year to year while the LDL levels decreased steadily [ 21 ]. An increasing number of consultations also implies the possibility that the doctor prescribed statins that improve LDL levels.…”

“…However, T2D requires improvements in all its clinical outcomes. In the same study from Finland, the proportions of patients whose HbA1c and LDL were measured yearly were 75–78% and 67–69%, respectively, with relatively minor overall changes over time [ 21 ]. According to our results, monitoring was more scarcely performed in the usual care group than in either of the care plan groups, which may indicate that the actual clinical outcomes in the usual care group may be even worse.…”

Type 2 diabetes medication and HbA1c levels in North Karelia Finland, 2013–2019

“…These organizational changes might also have had some effect on the continuity of the care of patients and further the outcomes of care. 22 The major strength of this study is that the electronic health records cover all adults with type 2 diabetes living in the North Karelia and includes data from both primary and specialized care, and therefore selection bias, nonresponsiveness and missing laboratory data were avoided. The validity of diabetes diagnosis in the electronic health records is high as diagnosis is based on explicit, predefined criteria (ICD-10 code E11).…”

“…At the beginning of 2017, a major change in the organization of health services occurred when the Joint Municipal Authority for North Karelia Social and Health Services was established, joining the health service organizations of 14 municipalities. These organizational changes might also have had some effect on the continuity of the care of patients and further the outcomes of care 22 …”

LDL-cholesterol trajectories and statin treatment in Finnish type 2 diabetes patients: a growth mixture model

“…In Finland, statin use has continuously increased among the general population and individuals aged over 65 years during 1995–2010 12 , 13 but after that remained stable in men and even decreased in women 2010–2015, leading to an increased sex gap in statin use 13 . A recent study on trends in T2D care in the North Karelia region, Finland, between 2012 and 2017 found increases in the LDL-C treatment target achievement (< 2.5 mmol/L) from 53.4 to 59.5% and in statin prescriptions from 65.7 to 71.0%, respectively 14 .…”